Expanding Regulated Private Sector Medicines Access - Experiences with Accredited Drug Dispensing Outlets Romuald Mbwasi, PhD

What is Wrong with Drug Sellers?

 Build private sector capacity Business skills of owners Dispensing and communication skills  Provide incentives Ability to sell expanded range of legally sold medicines Loans  Enhance availability and quality of products Products in stock approved by national drug authorities Local suppliers  Ensure quality of pharmaceutical services Record keeping Mentoring and supervision  Increase patient and consumer awareness Marketing Information and education ADDO program takes a holistic approach to address drug seller problem through a “package of interventions”

Decrease in Inappropriate Recommendation of Antibiotics for Upper Respiratory Tract Infection (URTI) Source: Management Sciences for Health SEAM Tanzania Final ADDO Report. Endline data of inappropriate antibiotic dispensing for URTI by ADDOs in the pilot region was 14% compared with 39% at baseline. At endline in the control region, 25 percent inappropriate dispensing was found.

Quality of Service (1) Percent of Drug Outlets Dispensing Malaria Treatment According to STG-Ruvuma Outcome measure: sustainability of quality of services

Quality of Pharmaceutical Products: Percent of products available in ADDOs that were Not Registered with TFDA

Availability of Antimalarial Products in ADS Uganda Outcome measure: dramatic decline of SP and CQ which are not recommended in the STG for uncomplicated malaria following accreditation in Kibaale

Challenges and Opportunities Although overall dramatic improvement in rational use is observed, gaps exists in management of certain conditions, like diarrhea Lack or minimal consumer education and advocacy is a challenge Collaboration with different health programs offers opportunities for improving rational medicines use The insurance schemes such as NHIF which has accredited ADDO is another opportunity for quality of services monitoring including rational medicines use While market can help in reducing price and improving availability, this should not be done at the expense of rational use of medicines and quality of services